Methadonsubstitution in der Schwangerschaft: Dosiswirkungsrelation bezogen auf das neonatale Entzugssyndrom

Abstract

Background: Treatment with methadone during pregnancy may lead to severe neonatal abstinence syndrome. This is a retrospective study of the symptoms, duration, course and therapy in babies diagnosed as having neonatal abstinence syndrome due to maternal methadone substitution. We sought to find if there is a relationship between dose and duration of methadone substitution and the severity of neonatal abstinence syndrome. Patients and Methods: We evaluated the following data on preterm and term babies of mothers substituted with methadone between 1994 and 2001: maternal dose of methadone, duration of substitution during pregnancy, supplemental maternal drug use, maternal infections, perinatal complications, symptoms, duration, course and therapy of neonatal abstinence syndrome. Results: There were 34 babies (27 term and 7 preterm) with a mean gestational age of 38.5 weeks. The mean birthweight was 2808 grams. 97 percent of the babies developed symptoms of neonatal abstinence syndrome which required treatment. The mean duration of treatment was 36.5 days. Four children whose mothers had taken a dose of methadone greater that 100 grams per day throughout the whole or the last two month of pregnancy had a longer duration of neonatal abstinence syndrome (mean 64.5 days; Pearson correlation coefficient: r = 0.4725). Apart from common withdrawal symptoms such as shivering and excitability there were 9 babies who had seizures. There was one baby whose mother had been detoxified as an inpatient, who had no withdrawal symptoms. Conclusion: Maternal methadone dose and the duration of methadone ingestion during pregnancy correlated with the severity of the neonatal abstinence syndrome. Use of methadone in a pregnant woman requires careful thought.